Diabetes and pregnancy

History of diabetes
Insulin was discovered for the use of diabetes in 1921. Prior to this discovery, juvenile diabetes meant death within 3-4 years. Pregnancy for diabetics prior to 1921 simply did not happen. Until 40 years ago at least half of all pregnant diabetics would loose their babies. However now over 90% of babies from diabetic mothers survive, due to modern technology. However, diabetic pregnancies are still at a high risk.

It is advisable that you seek a high risk pregnancy centre to assist you during your pregnancy as opposed to your standard clinic. It is better to take precautions than deal with problems as they arise.

Types of diabetes
There are two types of diabetes. Non insulin dependant diabetes, which can be treated with diet alone, and there is insulin dependent diabetes, which requires injections of insulin.

Diabetes has been broken into six different classes which enables you to determine your chances of a safe pregnancy.

Class A: gestational diabetes. That which is developed during your pregnancy.

Class B: Diabetes that developed after the age 20, but is 30 yrs of age or less. This can result in a healthy pregnancy provided the mother is healthy.

Class C: Diabetes developed between the ages of ten and nineteen, and diabetes has been existant for 10 to 20 years. No evidence of vascular problems or eye problems. A supervised pregnancy can be successful.

Class D: Have had diabetes for the same amount of time as group C, but who are experiencing deteriorating eyesight. There are chances of problems such as retinal detachment, so consultation with specialists is a priority.

Class F: These women have developed early kidney damage, as well as other problems. This could result is a risky pregnancy and consultation should be sought before pregnancy considered.

Class R: Women with retinal damage, damage to the heart and other organs. This group is usually advised against pregnancy, but see a specialist concerning this.

• Miscarriage rates are higher for women with diabetes.
• Greater chance of problems during labour and delivery with diabetic pregnancies.
• Greater chance of your baby being still born or having congenital abnormality, if you are diabetic.
• Congenital fetal malformations caused by diabetes.

A mother with diabetes has a much higher incidence of birth defects than a women without diabetes. A possible reason for this is the high blood sugar levels in the first three months of pregnancy. Possible birth defects are heart malformations, cleft lip and palate and missing kidneys and lungs. It is often the early months of pregnancy that cause the problems with blood sugar levels due to morning sickness, which causes them to eat less than they normally do. Therefore careful planning surrounding the first three months regarding blood sugar levels is essential. Remember to consume small meals frequently. Record blood sugar levels.

The delivery
Constant monitoring is essential during a diabetics pregnancy, as a time for delivery has to be decided upon. In comparison to a normal full-term pregnancy a diabetic will have more amniotic fluid and a greater blood supply to the foetus. Due to this lack of stress the delivery is not started naturally. Careful monitoring of fetal size and gestational age is vital for a diabetic mother.

Gestational diabetes
This diabetes is related to pregnancy and can appear in the second half of the pregnancy, even after you have already had three or four babies.

You can be tested for gestational diabetes by a blood test.

You have more chance of developing gestational diabetes if you are over 25, your last baby was over 9 pounds, being over weight or hypertensive.

If you do develop gestational diabetes you will be required to follow a special diet as well as regular monitoring of your blood sugar levels.

Will I need to take insulin if I have gestational diabetes?
Insulin is usually not required as diet is a good control. However in severe cases when blood sugar levels are so high it may be required, but only for the length of the pregnancy. Without such high blood sugar levels a normal sized baby should result, and normal sized babies are rarely still born.

Will I still have gestational diabetes when pregnancy is over?
After your pregnancy you will find that your blood sugar levels will return to normal. You should however be weary that there will be a possibility of gestational diabetes returning in further pregnancies. You will also have a greater risk of getting adult diabetes later in life. 




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